The bill requires that, as of July 1, 2007, all residents of the Commonwealth must obtain flood insurance coverage, even if they don't live in a flood plain.... The purpose of this "Individual Mandate" is to strengthen and stabilize the functioning of flood insurance risk pools by making sure they include people outside of flood plains with no flood risk as well as people who know they live in a flood plain.

The bill requires that, as of July 1, 2007, all residents of the
Commonwealth must obtain health insurance coverage.... The purpose of
this "Individual Mandate" is to strengthen and stabilize the
functioning of health insurance risk pools by making sure they include
healthy people (who, if not offered employer-sponsored and -paid
insurance, are more likely to take the risk of not having insurance) as
well as people who know they need regular health care services.

For years I have criticized the argument which says that the problem with the health care system is that there are too many uninsured people. My argument was always that there were many people who choose to self-insure, and that the real "problem," if there is one, is how many people there are who need care but can't get it (a much much smaller number that is never discussed). Just look at the attached bill - the justification is that there are people uninsured, not that there are people unserved. Now we can see the end result: Instead of fixing the actual problem, which is people who need care not getting it, they fix the problem as it was discussed: they literally forced people to get health insurance, even if they don't want or need it. Now some elected weenie can say "in Massachusetts, we have licked the problem of people without health insurance." Reminds me of this Rush song.

Like many parallel bills proposed in other states, this one requires businesses to provide health insurance or to pay into a state fund if they don't. But the bill also has this scary provision:

The Free Rider surcharge will be imposed on employers who do not provide health insurance and whose employees use free care. Imposition of the surcharge will be triggered when an employee receives free care more than three times, or a company has five or more instances of employees receiving free care in a year.

First, as an employer, why am I a free rider? It is not me that received any free services or care. My employees medical problem is not my fault (or else it would be workers comp). If I hire someone that takes advantage of government loans to send their kids to college, am I a free rider? If my employees choose subsidized mass transportation over driving their own cars, am I a free rider?

Second, I sure hope all you poorer folks with health problems understand that it is now going to be really hard to find a job in Massachusetts. No employer in their right mind is going to hire someone who may trigger this liability. This provision would be a disaster for our company, since we tend to hire older retired people (with lots of health problems) for seasonal work (for which it is impossible to structure a health insurance plan). Fortunately, I guess, Massachusetts is one of the states our company red-lined years ago as a place we will never do business, so this does not change our strategy much.

I have no idea what this will cost taxpayers and businesses in Mass.,
but I am positive it is substantially more than the bill's sponsors have
let on. And there is a lot of hand-waving going on by supporters who insist that this bill will drive premium costs way down that strikes me as bullshit as well.

Update: This article in Business Week provides some insight into the 500,000 uninsured in Mass. Supporters of the bill claim that 100,000 of these are poor people who qualify for Medicare but haven't bothered to sign up. 200,000 are higher income folks who could afford insurance but choose not to buy it. The other 200,000 are people they claim can't afford it, but surely even if they could, some portion would choose not to buy it. So by the admission of the bill's supporters, at least 60% and probably more of the uninsured are that way because they choose to be. Lets come up with a costly socialization of the medical industry in order to force on people something they don't necessarily want or need.

WM,
The article and my father say it's Medicaid, not Medicare that covers the poor people. Just a heads up.
Keith

jburns

From a quick view of the bill, it appears that employers have to offer health insurance to all employees, and the percentage covered by the employer has to be the same for all employees. I suspect, if this is the structure, we will see employers elect to not pay any of the premium directly. Salaries will adjust to account for this -- salaries in jobs where health insurance historically has been covered largely by the employer will increase to provide the employees with money to pay for the coverage themselves, while salaries in jobs where health insurance historically has not been provided will not change. The end effect will be no change in employer paid coverage. There will simply be more people who are receiving taxpayer subsidized health care because, frankly, they have no choice but to receive it.

Silent-Fire

I would have to say that this bill may help fix one of the problems with the health care industry today: incredibly high prices for uninsured individuals. Because hospitals are required to provide emergency care to everyone, they end up with a fairly large number of patients who don't ever pay for the care they receive. Meanwhile, the large health insurance companies negotiate lower rates for their customers, and so the prices for uninsured people go way up. ($500 before the price my insurance company negotiated ($150) for visit to the urgent care clinic, where I got 20 minutes with the doctor, a shot of antibiotics, and a prescription)

I'd like to see a requirement that hospitals and other care providers charge a fixed price for all patients, regardless of their insurance. If providers wish, they can offer some sort of sliding fee scale based on income, but for health care, I don't feel it's appropriate to charge different people different rates for the same procedure, depending on their insurance.